The Doctor's Corner: The why and how of hormones

This is the second of two articles updating women of all ages on the use of hormones.

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I had to bite my tongue while sitting at Zinc Cafe & Market in Laguna Beach (one of my favorite places) the other day. Two beautiful young women who looked to be in their early twenties sat across from me, both with bad acne, which can leave permanent scars. I doubted they could be using birth control hormones, now available as pills or via a nifty vaginal ring. In addition to reliable contraception, use of these hormones is a great strategy for clearing up skin problems and smoothing out a myriad of other hormonal challenges in women, paving the way for an easier menopausal transition.

In my experience, use of a spectrum of hormones can safely improve women's lives from puberty into menopause and beyond. What to prescribe, and when, is a clinical judgment call. There are many well-researched Food and Drug Administration (FDA)-approved choices on our treatment palette. (To disclose, I have been a medical speaker for manufacturers of FDA-approved bioidentical menopausal estrogen products.)

The American College of Obstetricians and Gynecologists published a practice bulletin elucidating the myriad non-contraceptive benefits of birth control hormones in January 2010. These include reduction of acne and facial hair, improvement in menstrual bleeding and pain, control of endometriosis and premenstrual syndrome, improvement in bone density and a marked reduction in the lifetime risk of ovarian and uterine cancer. Just think — all that, and contraception to boot! It is simple to recommend extended pill usage, reducing the frequency of menstrual periods. We can help women control their cycles for more carefree beach days. These are fantastic benefits, with minimal risks for women with healthy lifestyles.

As a transition strategy for non-smoking women, we may continue birth control hormones, including the vaginal ring, right up to the age of 54. This can mask the menopausal transition, again smoothing over the perturbations of hot flashes, irregular bleeding and moodiness.

Then, we can seamlessly move women to low-dose, non-oral menopausal hormone therapy (MHT). Overall mortality in women drops when MHT is started prior to age 60, as concluded in a combined analysis involving more than 100,000 women years published by Salpeter, et al, in the Journal of General Internal Medicine in 2004. A new study in the journal Neurology in October 2012 by Shao, et al, showed that use of MHT within five years of the onset of menopause was associated with a 30% reduction in the risk of Alzheimer's.

Dr. Alan Altman, past president of the International Society for the Study of Women's Sexual Health, who spent 30 years as an assistant clinical professor in obstetrics and gynecology at Harvard Medical School, said in a recent phone interview, "I believe the preponderance of data strongly supports the use of MHT for menopausal symptoms, and for the longer term prevention of cardiovascular disease, osteoporosis and osteoporotic fracture, vascular and Alzheimer's dementia, and all cause mortality when beginning MHT at the appropriate time, especially using it non-orally." As described in my first article in this two-part series, a recent Global Consensus Statement concluded that women extend life when they begin MHT prior to age 60, or within 10 years of the onset of menopause.

Two myths often impede the use of birth control and menopausal hormones. These are concerns about an increase in breast cancer and weight gain.

Women, consider getting off of the hormonal roller coaster of life. Use of safe, FDA-approved products can help you control your reproduction, your moods, your menstrual pattern, your cancer risk, your skeletal and cognitive health and, ultimately, your longevity.

(A note: this information is not intended as a substitute for individual consultation between women and their healthcare providers. See more at http://www.acog.org.)

DR. JANE K. BENING is a board-certified gynecologist who has lived in Laguna Beach and had a private gynecology practice in Newport Beach for 22 years. She can be reached at ask@drjanebening.com or at her office at (949) 720-0206.